Regional Compliance Coordinator

Primary Duties and Responsibilities : Works collaboratively with the regional Compliance Department and other enterprise Business Unit leaders, Subject Matter Experts (SMEs) and team members to process and complete compliance initiatives and activities according to Managed Care Compliance Program, Policies and Procedures, and regulatory standards. Job responsibilities include, but are not limited to, the following : Supports Compliance Department a. Supports the Regional Director in managing compliance requirements so as to maintain full delegation status with all health plans and maintain compliance with all regulatory and applicable accreditor standards. b. Serves as a resource for staff with respect to regulatory requirements, health plans.delegation agreements and provider operations manual requirements for assigned health plans c. Assist with preparing documents and training resources for staff to support compliance Audits internal and external a. Prepares materials for annual and focused health plan (for assigned health plans) and regulator audits, including document and evidence collection and organization. b. Completes audit tools in preparation for health plan annual and focused audits c. Prepares audit materials, and upon approval of Director, timely, accurately and completely submits final materials to plans and regulators d. Maintains complete and organized digital files of all audit material and communications per policy e. Works closely with Business Unit Leaders and Subject Matter Experts (SME) in preparation for upcoming live audits f. Sends reminders notices to stakeholders regarding upcoming audit g. Attends annual and focused live audits h. Works with Business Unit Leaders and SMEs to collect information and prepare responses to health plan and regulator corrective actions i. Follows up with business Unit leaders and SMEs to ensure remediation plans andcorrective actions are fully deployed to ensure compliance j. Assists Regional Director with Health Plan and First Tier Downstream and Related Entities (FDR) oversight audits k. Manages audit tracking tools for assigned health plans l. Assists Regional Director with internal audits as requests Assist Regional Director in development and updating initial and annual training materials for all new hires and first tier downstream providers, including but not limited to Fraud Waste and Abuse Training, and General Compliance, HIPAA etc a. Receive, track, manage all member and provider notification letters from assigned health plans using appropriate tracking tools b. Works with EIS team to manage configuration fr and timely deployment of all letter templates; ensures letters are tested for accuracy and proper triggering in the Tapestry system. c. File and document all changes / updates / retirements in letter template tracking system d. Ensure EIS has new templates and require samples with each change to verify implementation Compliance Department a. Assist Regional Director with annual compliance evaluation b. Complete and file OIG and SAM Exclusion screenings for, contractors, temp staff, , Vendors contracted with a letter of agreement, Vendors upon hire and monthly thereafter. c. Ensure receipt and filing of exclusion screening of employees and Boards of Directors on a monthly basis. d. Manage and respond to incoming compliance department emails, phone calls within 24hours to ensure communications are completed timely e. Report and escalate issues to management as needed f. Participates in and contributes to all department specific initiatives and department meetings. Additional duties a. Perform other duties as assigned b. Adheres to all telecommuting policies and procedures (if applicable). Telecommunicating is a privilege and must demonstrate strict adherence to HIPAA / PHI requirements as well as operational productivity. Knowledge, Skills & Experience Required :

• College degree from accredited institution
• 2-3 years' experience in managed care compliance strongly preferred
• 2-3 years' experience in project management
• Excellent written and oral communication skills
• Proficient data entry skills
• Proficient in Microsoft Office
• Excellent telephone and customer service skills
• Well-organized and a self-starter.
• Must be able to work independently with minimal supervision.
• Must be a problem solver, detail-oriented with excellent follow through
• Must be reliable and possess the ability to stay on-task during work hours.

Pay Range : $29.58 hr - $44.76 / hr #LI-CS1

#J-18808-Ljbffr